1Department of Stroke Medicine, King’s College Hospital, London SE1 6AW

Correspondence to: A A Mazumder asifmaz{at}gmail.com

A 77 year old right handed man presented after a collapse. He was found to have a dense right sided hemiplegia, with the right arm worse than the right leg and “forehead sparing” facial weakness. He was aphasic, with his gaze preference to the left. His symptoms had been present for 30 minutes and did not improve. No signs of meningism were present. Computed tomography of the head was performed immediately (fig 1⇓) and 24 hours after thrombolytic treatment (fig 2⇓).

Fig 1 Computed tomogram of the head at presentation

Fig 2 Computed tomogram of the head 24 hours after thrombolytic treatment

Questions

1 What feature is seen in fig 1?

2 What other stroke signs could be expected on examination?

3 What complication of treatment is evident in fig 2?

4 Using the assessment scale developed by the European Cooperative Acute Stroke Study (ECASS), which category does the scan in fig 2 fit into?